One treatment for heart failure includes biventricular pacing (BiVP), by which electrical signals are introduced at electrodes at two or more locations distributed across both the right ventricle and left ventricle of the heart to induce efficient and regular heart activity. A device that provides for permanent biventricular pacing is a biventricular pacemaker, which can be implanted through catheters without open chest or open heart surgery.
The process of implanting a left ventricle (LV) electrode for a BiVP pacemaker involves introducing a catheter two feet in length into a vein near a shoulder of the patient, and navigating the catheter into the right atrium and thence into an orifice into the coronary sinus. Once the guiding catheter is positioned in the coronary sinus, an angiogram is performed to delineate branch veins. Next, a pacing lead containing one or two conductors and typically 3 mm×65 cm in length is advanced into a branch vein. The tip of the catheter is guided using any X-ray fluoroscopy and an over-the wire technique. Even so, a skilled electrophysiologist with several hours of time available, is unable to successfully place the electrode end of the LV lead in a branch vein about 10 percent of the time. In such cases the procedure is a failure and other means to treat heart failure have to be called upon, including biventricular pacing via an epicardial (open chest) approach.